Healthcare Provider Details

I. General information

NPI: 1083171441
Provider Name (Legal Business Name): ADRIENNE MARIE DUSKY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

1335 E ELZA AVE
HAZEL PARK MI
48030-2356
US

V. Phone/Fax

Practice location:
  • Phone: 313-473-1629
  • Fax:
Mailing address:
  • Phone: 248-915-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: